Provider Demographics
NPI:1396566188
Name:MYERS, KERRY A
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3229
Mailing Address - Country:US
Mailing Address - Phone:216-535-9100
Mailing Address - Fax:216-535-9100
Practice Address - Street 1:1530 SAINT CLAIR AVE NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2004
Practice Address - Country:US
Practice Address - Phone:216-535-9100
Practice Address - Fax:216-535-2626
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPW513628172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver